Salary: $49,330.00 Annually
Location : New Bern, NC
Job Type: Full-Time
Job Number: 10279
Department: Social Services
Division: Income Maintenance
Opening Date: 08/02/2023
Closing Date: 8/16/2023 11:59 PM Eastern
Primary Purpose
The primary purpose of this position is to educate, prevent, discover and recover overpayments/over issuance related to fraud in cases of the income maintenance programs. Work at this level requires reviewing clients’ case files and making decisions as to the appropriate action to take in resolving the case. Employees determine if errors exist and, if so, the cause of the errors. Investigators initially evaluate case referrals to determine if the referral is valid and whether a more in-depth review is required. Where the cause of the error indicates potential client fraud, the worker is responsible for investigating the case and determining the appropriate course of action required to resolve the case. Work also involves working with clients to settle cases out of court, representing the agency in negotiating out of court settlements, and developing and working with the prosecutor in presenting the case in court. They also have a substantial involvement in the administrative hearing and judicial process and the recoupment of agency errors. The investigator works with a considerable degree of independence investigating alleged fraud in programs operated by the Department of Social Services
Essential Functions
INVESTIGATION – (55%) The investigator is responsible for investigating cases of suspected fraud as a result of a recipient’s failure to report changes in their situation or because of the recipient’s willful withholding of information with the intent of receiving benefits to which they were not entitled The investigation process consists of:
The investigator follows the fraud plan which has been approved by the Social Services Board. The investigator presents those cases recommended for prosecution to the District Attorney’s office and to the Grand Jury when appropriate. The investigator is responsible for working with the District Attorney and any other law enforcement agency necessary in representing the department of social services in cases suspected of fraud that are to be disposed of through the court system. The investigator is also responsible for the disposition, through the appropriate administrative procedures of cases that are not prosecuted.
The investigator informs interested and concerned citizens of the various program policies to educate them and maintain program integrity. The investigator works with a variety of community contactsto fulfill the job duties/responsibilities.
The investigator receives referrals of suspected program violations from agency staff, County Commissioners, anonymous phone calls, concerned citizens, ex-friends of the client in question, store managers or any member of the general public. The referrals are logged in a master log and disposed on by the investigator. The investigator is responsible for investigating any and all referrals received by the investigative unit regardless of the reason or basis of the referral.
The primary source of referrals to the program integrity unit are through employees of the Department of Social Services. Other referrals come from the general public, Community Agencies, IRS, Financial Resource Report (FRR) and the Beneficiary Earnings Exchange Report (BEER). This position has a consistent caseload and is expected to be completed per policy guidelines.
Supervisory sessions are conducted on a regular basis depending on the skill, training and expertise of the staff person. Supervisor, director or others are consulted when instruction/interaction/suggestions are needed for an individual case. The supervisor reviews all reports submitted, all letters requiring a signature and attends, on a random basis, interviews conducted with recipients.
The Income Maintenance Investigator is part of a specialized fraud investigative initiative. Successful completion of public assistance fraud investigation requires a high degree of specialization. The investigator must develop a sound working knowledge of the public assistance programs, i.e., Food & Nutrition Services, Work First Family Assistance, Medicaid, Special Assistance, Daycare and Services.
The investigator is responsible for reassessing eligibility in Food & Nutrition Services, Work First Family Assistance, Family and Children’s Medicaid, Adult Medicaid, State/County Special Assistance, Daycare and Service programs.
The investigator presents cases suspected of fraud to the District Attorney’s office and Grand Jury. During the presentation of cases to the District Attorney, questions sometimes arise in which the investigator must explain the different program policies according to the manual sections of the program in question. The investigator also testifies in court for cases prosecuted for suspected fraud.
Occasionally the investigator receives a referral as a result of a quality control review to investigate facts given by the client to a quality control reviewer that are not documented in the case record. The investigator must re-verify information that the quality control reviewer may already have verified, re-determine the amount of assistance, process the claim and take appropriate action. Also, corrective action plans are developed as a result of the quality control review that reveals errors in programs relating to client eligibility.
COLLECTION – (25%) Maintains control on collection activities for all cases where an overpayment/over issuance exists. This includes checking expungement report and applying expunged benefits as a payment on claim balances, preparing payment documentation for administrative support to key payments in EPICS, sending notices to clients, debiting EBT accounts for payments to claim balances, establishing payment contracts with the clients, identifying potential wage garnishment cases based on debtor’s employer, document contact from clients who respond to notices of delinquency.
ADMINISTRATIVE DUTIES – (10%) Administrative forms and reports are prepared daily, monthly and quarterly. The investigator performs other duties assigned that are related to the job and any other duties assigned by the supervisor or director.
COURT APPEARANCES – (5%) The investigator presents investigative cases to the Grand Jury if the District Attorney’s office determines there is sufficient evidence to warrant prosecution and requests this. The investigator provides documents and the names of witnesses necessary to strengthen the court case and works with the county attorney in proposed litigation. Provides testimony in court.
TRAVEL – (5%) Travels to and from interviews, meetings, workshops and conferences outside the agency. Travel is also necessary for collection and verifying unreported information.
Minimum Education and Experience
An Associate Degree in Human Services Technology, Social Services Associate, Paralegal Technology, Criminal Justice, Business Administration, Secretarial Science or closely related curriculum and two years of experience as an Income Maintenance Caseworker or Investigator; or, graduation from high school and three years of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; or graduation from high school and two years of investigative experience in credit, legal, or law enforcement work plus eighteen months of experience as an Income Maintenance Caseworker or Income Maintenance Investigator; or an equivalent combination of training and experience.
Craven County offers regular full-time employees a wide variety of employee benefits including:
Health Insurance
Health Insurance is provided by ACS Benefits Services and covers a wide variety of healthcare services. Craven County pays 100% of Employee Only premium cost. Employees have the option to add child and spouse dependent coverage at their own cost.
Dental Insurance
Dental Insurance is provided through the Delta Dental PPO and Delta Dental Premier network administered by ACS Benefits Services. It covers a percentage of basic to major dental procedures, including orthodontia for children. Craven County pays 100% of Employee Only premium cost. Employees have the option to add child and spouse dependent coverage at their own expense.
Life Insurance and AD&D
Craven County provides eligible employees with $10,000 life insurance and accidental dealth and dismemberment coverage through OneAmerica AUL. Employees have the option to purchase additional coverage and/or dependent coverage at their own expense.
Disability Insurance
Craven County provides eligible employees with $50.00 per week in disability insurance through OneAmerica AUL. Employees have the option to purchase additional disability insurance at their own cost.
North Carolina Local Governmental Employees’ Retirement System
Eligible employees are automatically enrolled in the retirement system and must contribute 6% of their gross salary each pay period. Once eligibility requirements are met, employees will be able to receive monthly payments for life based on their salary, age, and years of service credit.
NC401k
Craven County contributes 2% of eligible employees’ gross salary into the 401(k) account regardless of the employee’s deferral amount. In addition, the County matches employee deferrals up to an additional 3%.
Annual Leave
Regular full-time employees earn annual leave based upon years of service. Eligible employees begin to accrue annual leave as soon as they start but must complete a six month probationary period before they are eligible to use annual leave.
- Less than two years of service earns 10 days per year.
- Two but less than five years of service earns 12 days per year.
- Five but less than 10 years of service earns 15 days per year.
- 10 but less than 20 years of service earns 18 days per year.
- 20 or more years of service earns 20 days per year.
Sick Leave
Regular full-time employees earn 3.69 hours of sick leave per pay period. Craven County accepts eligible sick leave from the State of North Carolina, any of its political subdivisions, any local government entity or authority, or municipality in North Carolina.
Paid Holidays
County employees receive 11-14 paid holidays annually. The Board of County Commissioners may adjust the holiday schedule as deemed necessary.
Longevity
Eligible employees earn $200 in longevity after five years of service by October 31 of the qualifying year. Longevity benefits increase $25 per year up to a maximum of $1,000.
Merit Program
Craven County offers a merit program. Up to 56% of eligible employees may receive a performance-based merit increase each year.
Supplemental Benefits
County employees are also offered a variety of supplemental benefits to select at their own expense such as Life Insurance, Vision Insurance, Flexible Spending Accounts, Critical Care policies, Cancer policies, Long-term Care policies, Hospitalization policies, 457b Deferred Compensation Plan and Aflac.
Employee benefits are subject to change or may be contingent upon funding availability.